Each week I try to come up with a new and compelling blog post to discuss issues involving drug prices and problems Americans are having affording medications. I often find myself resoundingly critical of the pharmaceutical industry and this week I was intrigued but curiously put off to be joined by a pharmacy corporation that made over $100 billion last year.

Express Scripts, the nation’s largest pharmacy benefit manager, reported that brand name drugs in the U.S. cost 98.2% (about twice) more on average today than they did in 2011. Last year, brand name drug prices were up 16%. As I read in the Chicago Tribune, Express Scripts used hostile, downright anti-big pharma (and pharmacy) language blaming “opportunistic manufacturers” and “scheming pharmacies.” Rising drug prices of this magnitude are no laughing matter as cash-strapped Americans bear the brunt of these increases, either in higher insurance premiums, co-payments, co-insurance and full cash prices for uninsured (still almost 30 million Americans), or when plans don’t cover certain drugs.

But it is a little funny to hear Express Scripts go after Big Pharma using the rhetoric of greed. After all, PBMs, particularly Express Scripts, are often criticized for their lack of drug pricing transparency and profit-seeking practices, kind of like drug companies and big pharmacies, such as Walgreens and CVS.

While the focus of Express Scripts’ ire is on brand name drug prices, most of the prescription sales it administers and profits from are generics. On that note, buying generic medication without using your insurance’s PBM is often less expensive than your co-payments. But don’t expect Express Scripts to tell you that.

So that Express Scripts doesn’t feel singled out, we’ve reported on the antics of Big Pharmacy before, including Express Scripts’ biggest competitor. PharmacyChecker CEO Tod Cooperman, MD, was on Fox and Friends not so long ago discussing an investigation of CVS Caremark in which the company was accused of price gouging. The allegation: by not informing its customers that the cash price using CVS’ own discount card program would be lower than co-payments using PBMs, such as CVS Caremark or Express Scripts, hundreds of thousands of customers were overcharged.

On that note: the nuts and bolts message is DON’T BE SHY and ask for the lowest possible price at your local pharmacy.

In defense of Express Scripts, and even CVS Caremark, PBMs and large pharmacy corporations do not yield profit margins even close to those of the biggest drug companies. Furthermore, the pharmacy corporate giant, Express Scripts, is right: the blame for ever increasing drug prices falls on opportunistic manufacturers and scheming pharmacies.

A new report by Express Scripts has found that medication spending by commercial health plans grew by 13.1% last year, primarily due to the release of high cost Hepatitis C meds. Spending also increased significantly for compounded drugs. In the prior decade, total spending ranged between three and six percent.

Keep in mind that the headline statistic of 13.1% applies to how much was spent on drugs; it actually doesn’t tell us anything about the prices of the drugs. If drug utilization, which refers to the amount of drugs taken, increases while prices stay the same, then there’s more spending. As it turns out, utilization decreased by a marginal 0.1 % and d prices increased by 13.2%, demonstrating that drug costs were the primary cause of increased drug spending. In fact, a vice president at Express Scripts referred to the drug price increases as “unprecedented and unsustainable.”

Specialty drugs, which often require careful handling, administration, or monitoring, saw a dramatic 30.9% increase in spending. As mentioned earlier, spending on hepatitis C treatments was the primary driver in overall spending, skyrocketing by 742.6%. Other notable (though nowhere near even 100%) increases include 20% for oncology drugs, 24% for treatments for inflammatory conditions, and 17% for hemophilia drugs. It’s not uncommon for these medications to cost many thousands, even tens of thousands of dollars per month. Sovaldi, a hep C drug, costs $1,000 per pill. We covered the Sovaldi saga in depth.

The story for traditional medications, such as those commonly used to treat asthma, depression, diabetes, GERD, high cholesterol, and pain is much more mixed. Despite drug prices rising by 6.4% overall, prices dropped for five out of ten therapy classes. Depression medication prices, for example, plummeted by 18%. Interestingly, the report noted compound drugsas a therapy class, even though they treat a variety of conditions. These drugs had an unusually large price increase of 128%! Excluding compound drugs, drug prices for traditional meds were up only 2.3%. (more…)

For most industries, prices were stagnant in 2009. In fact, the consumer price index was down 0.4% last year (ftp://ftp.bls.gov/pub/special.requests/cpi/cpiai.txt). But according to the Wall Street Journal, drug prices in the United States were up by 9.1%, the largest increase in more than a decade. Below is an analysis of the prices of two popular prescription drugs identified in the WSJ as showing the greatest increases, the cost for an uninsured American at a local New York City pharmacy, and how much they could save through personal drug importation via a verified online pharmacy.

Per Pill Cost[i]

Potential Savings

Medication Name: Brand (Generic)

Strength

U.S[ii]

Canada[iii]

NZ/UK[iv]

Canada

Other Int'l

Overall

Tegretol (Carbamazepine)

200mg

$2.87

$0.77

$0.57

73%

80%

80%

Cleocin HCl (Clindamycin) [v]

300mg caps

$24.00

$3.38

NA

86%

NA

86%

Catapres (Clonidine HCl)

0.1mg

$3.34

$0.45

NA

86%

NA

86%

Sandimmune (Cyclosporine)

100mg /mL 50mL

$664.84

$327.98

NA

51%

NA

51%

Lanoxin (Digoxin)[vi]

0.125mg

$12.54

$0.75

NA

94%

NA

94%

Depakote (Divalproex)[vii]

250mg

$5.73

$0.90

NA

84%

NA

84%

Zarontin (Ethosuximide)

250mg

$4.51

$0.66

NA

85%

NA

85%

Synthroid (Levothyroxine)

100 mcg (0.1mg)

$1.87

$0.35

$0.63

81%

66%

81%

Dilantin (Phenytoin)

100mg

$1.45

$0.33

$0.48

77%

67%

77%

Depakene (Valproic acid)

250mg

$5.76

$0.93

NA

84%

NA

84%

Coumadin (Warfarin)

5mg

$3.69

$0.60

NA

84%

NA

84%

*Prices as of 4/21/2010

The chief medical officer of Express Scripts, one of the largest pharmacy benefit mangers, is quoted in the article as saying that the price increases on brand name drugs were “exacerbated by the health-care reform debate,” suggesting that drug companies are jacking up prices before they are required to give rebates under Medicaid and Medicare. Some pharmaceutical companies countered that their “price adjustments,” in part, were based on a strategy to ensure consumer access to medications. Raising prices at rates not seen in a decade doesn’t seem like a great way to ensure consumer access to medications, especially during a year plagued by economic recession and major job losses.